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My father is 84 years old


& fell at night in the ALF. The skin on his arm is delicate & broke open (lots of blood) but he said he did not hit his head.



No one from the ALF called me. The first time I heard about it was today when I picked him up for lunch. The manager said “just so you know the doctor ordered a bandage on his arm because his skin broke open. They are coming again next week.”



When I spoke to my dad he told me he fell & his arm hit the floor & started bleeding.



When I went back & spoke to the manager she said “Yes…I’m sorry. I met with the staff & told them they have to call the family no matter what. It seems like we’re hiding something if not.”



They called his doctor the next day but I am just shocked & very upset. This ALF has been great up until now.



What should I do? Aren’t they required to notify the family if something like this happens? What should be the next steps? My mother & grandmother both died soon after a fall so I’m very worried. Thank you for any & all help!

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Call "the family". Is there a chance they called someone else in the family? They generally only have one contact person. They're not going to call every child, grandchild, and father’s brother’s nephew’s cousin’s former roommate over a fall.

Either way, meh, let it go if it's been great up until now. Accidents happen.
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Nothing in life is perfect, we are humans who make mistakes.

If the ALF has been doing a good overall job why not let the upset go for now. If it happens again then I would make an issue of it.

He is not in a nursing home, AL is not as controlled. You seem to be hung up on the fact they did not call you, not that he is ok.
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Usually, the person who falls is evaluated by a nurse for injuries. If there are no injuries or the injuries are minor, the facility might opt to treat and provide closer observation. Some facilities require every person who falls to be evaluated in the ER. Read the contract with the facility about falls. If they say they will notify you for all falls, remind them of this. If not, speak to management that you want to be notified about all falls, even the minor ones.

Sorry that you have lost loved ones after serious falls. In my experience as a hospital-based RN, most falls in seniors are not serious.
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Yes, our state requires they notify the family of all alls.
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Pjdela Mar 2023
Yes, our facility was required to notify the family when any fall occurred as well. Mom, who was in assisted living, fell during covid lockdown and I was not allowed in to see her. I spoke to her by phone and they evaluated her and sent me pictures of her bruises so I could see for myself.
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Yes , they should have called. But I know how hard caregivers work.. you took the right steps .. Let it go…
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Did you sign the waiver that gives the facility the authority to do what they think best (like contacting an ambulance) before contacting you? Facilities do that under the guise of "if something goes wrong, we want all our energies focused on the problem at hand".

I'd check the contract.

As for your father's fall, I'd like to suggest that you get him PT ASAP. PT can prevent falls. Also, if you do PT, I'd suggest that you do the exercises with him or somehow get someone to ensure that he does them. It also helps if you knew what made him fall as that will tell you which set of muscles need to be stronger to prevent the fall. If he is using a cane on a full-time basis, my opinion is, use a walker. Using a walker forces the person to walk more similar to how one walked their adult life. In addition, you can get a basic walker completely paid for by Medicare.

I just finished a "Safe Falling" class. I found out that controlling and preventing the fall has a lot to do with balance and how strong your core is.
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Yes-a fall in assisted living should result in a notification to the family. My mom's fallen twice and they've called me right away. If you're not satisfied with the manager's response you can take it up with the director. Ask to see the fall policy.
Additionally, you can report it to the ombudsman in your state, and they can investigate it if you would like them to follow through. If the state maintains an online database of ombudsman investigations, it would show up there once the investigation was concluded.
https://acl.gov/programs/Protecting-Rights-and-Preventing-Abuse/Long-term-Care-Ombudsman-Program
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Agree with CW, this is an assisted living, not a nursing home! Assisted living does not check on residents throughout the night unless there is some scheduled care. Mom's hubby when he first moved to AL fell in his closet one night and spent the night there, they do not check AL throughout the night! My MIL was in AL, had a stroke and heart attack in the night. They did not check on her until she did.not show up for breakfast.

This is assisted living, not a nursing home.

And of course, staff reported both falls to family when they were discovered.

I am really sick of some of the know-it-all attitudes here! Users correcting other users, the challenging of who is right!

Maybe it is the full moon?
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AlvaDeer Mar 2023
You are, I believe, absolutely correct. I failed to take into consideration this difference. Thanks for this reminder, Glad.
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wintering6: It's really common sense for the facility to advise you that your father fell right after the fall event. Perhaps the manager could have handled it differently, although you were advised after the fact.
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"Are Nursing Homes Required to Tell You When Family Member is Hurt?
Yes
Nursing homes are legally obligated to take reasonable steps to inform the person identified as the resident’s contact in the nursing home admission contract or the resident’s responsible person when they are injured or have other changes in their physical or mental status.
Residential care facilities are also required to notify the residents responsible person or contact.
It is a huge red flag when a nursing home fails to inform family members and representatives regarding injuries or other changes in status. If you are concerned, you may contact my office for a free case evaluation.
As you can see below, California and Federal Law are very clear on this point.
Nursing Home – California Health & Safety Code § 1795(a)
Nursing homes are required to make reasonable efforts to notify you if your family member or loved one is injured. Ca. Health and Safety Code §1795(a).
(a) Notwithstanding any other provision of law, a skilled nursing facility as defined in subdivision (c) of Section 1250 , any intermediate care facility, as defined in subdivision (d) , (e) , (g) , and (h) of Section 1250 , a congregate living facility, as defined in subdivision (i) of Section 1250 , or a hospice facility, as defined in subdivision (n) of Section 1250, shall make reasonable efforts to contact the person named in the resident’s admission agreement as the resident’s contact person, or the resident’s responsible person, within 24 hours after a significant change in the resident’s health or mental status.
Nursing Home – Federal Code of Regulations – 42 CFR 483.10
Federal law also requires notification. See, Residents Rights under 42 CFR 483.10 et seq."
So the above is from the FikesLaw web page.
It appears that it is necessary both under California (my own state) and federal law to notify the family member who is listed as the "responsible party" in the patient's admission papers. Your admin already apologized. If you have reason to believe this may often happen then you should perhaps contact an ombudsman about this particular incident. That person will be able to see if they are seeing repeated infractions of the law. Wish you good luck, and hope for no falls in future.
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cwillie Mar 2023
but the OP says her father is in an AL not a nursing home... where I am the regulations covering them are very different
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At this point being the first time, it has happened, I think you are overreacting. If it happens again (not being informed) then you need to have a sit down the admin. My father's AL would call me middle of the night over his many falls. I asked them to wait until morning to call if it wasn't serious. 3am calls when you have to be at work the next day are not nice to get.
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JoAnn29 Mar 2023
I agree but my daughter, RN, says NHs are obligated to call when the fall happens. If she was working an 11 to 7 shift, she would wait until the end of her shift but the call had to be made by the staff person who had found the resident had fallen.
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Put your/his wants and needs in writing (to the manager/director) and send it registered mail. Next time, request Adult Protective Services to evaluate protocol(s). Do they post state laws on the site?
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Its not just protocol, I think its a law. ALs are under State laws just like any care facility. I got a call 3am in the morning the aide told me Mom fell out of bed. The problem getting that call at 3am usually means something bad has happened. I get heart palpitations and it takes a while for me to settle down and get back to sleep. My daughter says she made the calls at the end of her shift if doing 11 to 7am shift so it wasn't too early for family. But, the call has to be made during that aides or nurses shift.

This could be just one of those things. New aide who has no idea what to do and and no one around to ask. You have talked to the manager and he has brought it to his staffs attention. The aide may not have thought it was bad enough to call u and wake u up. They are called skin tears and it won't be the first time Dad will get them. They are very hard to close up. I have tried. DD brought me strips to use on my Mom.
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Dad is in assisted living. He wouldn't necessarily even tell staff he fell. So staff wouldn't know to even call you. If dad is competent which I imagine he is since he is in AL it is his job to tell you, not staff's.

Relax and breathe. It sounds like you are assuming that staff knew of the fall immediately which would not be typical in assisted living. And it was during the night. Maybe dad did not see the point of calling you because it was too late?
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wintering6, when my Dad lived in senior living [Independent Living, later Memory Care], the only time the Staff called me after a fall was if Dad needed to go to the hospital.

On the other side of the coin, when my Mom was living in skilled nursing facility as she was a major fall risk, could no longer stand/walk, I would be getting numerous calls all day long, even in the middle of the night, and wee hours of morning.

Once the phone rang during sleep, I couldn't get back to sleep. Believe me, the phone ringing was very exhausting. I asked that only serious falls be transferred to me, but the facility rules were calls for every fall. Even if my Mom had rolled off the lowered bed unto a safety mat.

Therefore, if you want every fall, no matter how minor, be forwarded to your attention, be ready.
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Yes. It's protocol for the ALF to notify the POA when a loved one falls, even at night. This ALF did not notify you, admitted it, and seem to be taking steps to correct that mistake for next time. What should your next steps be? Do you want your pound of flesh for a non emergency situation that occurred that WAS handled, aside from the not calling you part? Do you want to report this ALF to the powers that be, and then what? Move dad out, in spite of the fact his doctor IS involved and treating him?

My mother fell 95x while living in AL and Memory Care. I had PTSD from hearing the phone ring informing me mom fell but was fine, etc. I prayed they'd STOP calling me, to be honest, so I could stop jumping thru my skin every time the phone rang.

Regardless of what happened with your mother and grandmother, falls happen with elders all the time. Your father will live until his slot of time is up and God calls him home. And nothing you say or "do" will change that outcome.
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Are you the POA? If so, yes you should have been notified. Apparently staff did not report? And it seems the admin is attempting to correct this. Falls are frequent in these facilities and I was told that if there is no head injury and the person is watched then there is no MD called and no ER. If a fall injures head it is for ER trip to diagnose.
This was wrong. You spoke to them. Hopefully they will call now for all falls. And as far as the skin you are likely aware of the great fragility. Skin, a small layer can literally be rubbed off by hand in us elders. Not much to be done about that. I can just brush something and one of those purple close to the surface things shows up, going all wine-colored later. Any further brushing against something will just take that layer right off.
Not much you can do except have WRITTEN in his careplan to call for EVERY fall, that is if you are the POA and the one to be notifed.
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Don't get hysterical based on your mother and grandmother's situations. Older people fall all the time, and sometimes it leads to serious injuries and sometimes it doesn't. This time it didn't, and the AL handled it just fine.

They know now to inform you no matter what. I guarantee you'll be receiving endless calls if your dad even brushes up against a wall, because that thin skin tears and bleeds even if you look at someone cross-eyed. My dad had a similar problem, and yes, he brushed against a wall without even realizing it and five minutes later looked like an axe murderer had had a go at him. He did not, however, lose a ton of blood, and it wasn't a crisis.

Try to keep your head about you. If you get this wound up over a minor issue, you'll never be able to handle a true crisis. Trust the AL people.
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If they'd told you, what would you have done that they hadn't already done?
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wintering6 Feb 2023
My mom & grandmother died shortly after a fall. Many elderly do. Isn’t it protocol to call the family after something like this?
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If your father chose not to inform you that's his right, exactly as if he was living independently. People who reside in assisted living are supposed to need minimal assistance with ADLs and have enough agency to inform family themselves (or not).
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wintering6 Feb 2023
No the ALF did not inform me. My father is the one who told me about the fall.
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